Organization · NPI-2

Advanced Imaging Of Port Charlotte

Radiology, Diagnostic Radiology · Port Charlotte, FL

NPI number1225361850
StatusActive
Last updated in NPPESOct 28, 2009

Details

NPI
1225361850
Entity type
Organization (NPI-2)
Legal business name
Advanced Imaging Of Port Charlotte
Organization subpart
No
Enumeration date
Sep 15, 2009
Last updated
Oct 28, 2009

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
2085R0202X Radiology, Diagnostic RadiologyHCC6183FLYes

Practice location

2625 Tamiami Trail
Unit 1
Port Charlotte, FL 33952

Phone 941-235-4646 · Fax 941-235-4667

Mailing address

2625 Tamiami Trail
Unit 1
Port Charlotte, FL 33952

Phone 941-235-4646 · Fax 941-235-4667

Authorized official

Thomas Fabian
Medical Director
9412354646

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